Healthcare Provider Details

I. General information

NPI: 1114351210
Provider Name (Legal Business Name): KEN RAHM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23703 STATE LINE RD
LAWRENCEBURG IN
47025-9132
US

IV. Provider business mailing address

23703 STATE LINE RD
LAWRENCEBURG IN
47025-9132
US

V. Phone/Fax

Practice location:
  • Phone: 812-637-0209
  • Fax:
Mailing address:
  • Phone: 812-637-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.339745
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: